KIM’S ACADEMY OF ROY
Adult Belt Examination Application Form (Online)
Examination Date: Month ___ _ /Day __ __/Year
Student’s Name: ______Date of Birth Month ______/ Day ______/ Year ______Current Rank: ______
Poomse’s (Form): ______
**Belt Size**: ______
***Personal Hygiene is MANDATORY. (Especially Finger & Toe Nails)
Dear Student:
Please take a few moments to answer the following questions. The purpose of this information is to find out more about your Taekwondo training. Listing the requested information below will help us to better serve the needs of our students! Please complete the information below.
1. Please list 3 areas of Taekwondo you have improved since the last promotional testing or starting our Taekwondo program! (Areas include: Kicks, Punches, Forms, Breaking, and One-Step-Sparring)
a.
c.
2. Please List 3 areas you feel need or would like to improve before the next promotional test! (Areas include: Kicks, Punches, Forms, Breaking, and One-Step-Sparring)
Student remarks/suggestions: ______
______
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I recognize that belts and certificate are awarded only when specific standards of performance are met. In the event that I may not perform to the satisfaction of the testing official(s), promotion maybe delayed until further progress has been demonstrated. If I do not achieve the desired degree, I may retest for that degree when my instructor deems necessary. I recognize that promotion standards are uniform and that each belt degree reflects specific level of competence.
Signature: ______Date: ______/______/______
Thank You for taking the time to fill out this form. Please be sure to sign and return this form one week prior to the examination date so I can order your belts and print and Sign your Certificates.
EXAM FEE: $______Check / Cash / Credit Card (Circle one) PLEASE MAKE CHECKS PAYABLE TO “Kim’s Academy”
Examinee’s Name______AGE: ______
********************************OFFICIAL USE ONLY!************************************
*Appearance: A, B, C, F. A = Excellent B = Average C = Sub-Average
*Attitude of Answers, and Manners: A, B, C, F.
*Philosophies/ Knowledge: A, B, C, F.
*Questions/Answers: A, B, C, F.
*Poomse’s / Forms: Kicho / Taeguek ______Jang: A, B, C, F.
A = Excellent B = Average C = Sub-Average Needs work on______
*One-step Sparring:
(#1): A, B, C, F. A = Excellent B = Average C = Sub-Average
(#2): A, B, C, F. Needs work on______
(#3): A, B, C, F.
*Self-Defense Combinations:
(#1): A, B, C, F. A = Excellent B = Average C = Sub-Average
(#2): A, B, C, F. Needs work on______
(#3): A, B, C, F.
*Free Sparring: (if applicable) A = Excellent B = Average C = Sub-Average
Round 1: A, B, C, F. Needs work on______
Round 2: A, B, C, F. Needs work on______
*Breaking Technique:
Hand: 1st, 2nd, 3rd, 4th, Fail
Foot: 1st, 2nd, 3rd, 4th, Fail
*The awarding of more than 2 “C” or any “F” Student will need to re-test
PASS RETAKE (circle one)
______Date: _____/_____/______
Grandmaster Yong Woo Kim
______Date: _____/_____/______
Shawn Hugh